Brennan Report - Department of Health and Children
Brennan Report - Department of Health and Children Brennan Report - Department of Health and Children
Report of the Commission on Financial Management and Control Systems in the Health Service11 IMPLEMENTATION 12011.1 OVERVIEW 12011.2 DECISIONS BY GOVERNMENT 12011.3 MANAGING CHANGE 120Concentrate on Core Health ActivitiesImplementation CommitteeDelivering Change11.4 DETAILED GUIDANCE ON IMPLEMENTATION 123Timeframe for ImplementationIT Systems Implications of the Recommendations11.5 CONCLUSION 124ADDENDUM 125APPENDICESAppendix 1 - Commission Member Biographies 149Appendix 2 - Groups/Individuals Invited To Make Submissions 152Appendix 3 - Statutory Health Service Providers 154Appendix 4 - Description of the Estimates and Allocations Process 160Appendix 5 - Diagnosis Related Groups/Casemix 175Appendix 6 - Audit of Structures 179Appendix 7 - Extracts from the Consultants’ Common Contract 180Appendix 8 - Integrated Management Reports 183Appendix 9 - Investment in Information Technology in the Midland Health Board 184
Executive SummaryEXECUTIVE SUMMARYThe Commission carried out a detailed examination and review of the financial management andcontrol systems in the Irish health service.The Commission found problems in the existing systems, including:●●●●The absence of any organisation responsible for managing the health service as a unifiednational system.Systems are not designed to develop cost consciousness among those who make decisions tocommit resources and provide no incentives to manage costs effectively.Insufficient evaluation and analysis of existing programmes and related expenditure.Inadequate investment in information systems and management development.The Commission adopted four core principles in addressing the problems:●●●●The health service should be managed as a national system.Accountability should rest with those who have the authority to commit the expenditure.All costs incurred should be capable of being allocated to individual patients.Good financial management and control should not be seen solely as a finance function.The Commission made 136 recommendations including:●●●●●●●●The establishment of an Executive to manage the Irish health service as a unitary nationalservice.A range of reforms to governance and financial management, control and reporting systems tosupport the Executive in the management of the system.The designation of clinical Consultants and General Practitioners as the main units of financialaccountability in the system.Substantial rationalisation of existing health agencies.All future Consultant appointments to be on the basis of contracting the Consultants to workexclusively in the public sector; more transparent arrangements for existing Consultants.Reform of the medical card scheme to include a Practice Budget for each GP,monitoring of activity and referral patterns etc.Strengthening the process of evaluation of clinical and cost effectiveness for publicly fundeddrug schemes.Pending the establishment of the Executive, the creation of a high level and well resourcedImplementation Committee.5
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<strong>Report</strong> <strong>of</strong> the Commission on Financial Management <strong>and</strong> Control Systems in the <strong>Health</strong> Service11 IMPLEMENTATION 12011.1 OVERVIEW 12011.2 DECISIONS BY GOVERNMENT 12011.3 MANAGING CHANGE 120Concentrate on Core <strong>Health</strong> ActivitiesImplementation CommitteeDelivering Change11.4 DETAILED GUIDANCE ON IMPLEMENTATION 123Timeframe for ImplementationIT Systems Implications <strong>of</strong> the Recommendations11.5 CONCLUSION 124ADDENDUM 125APPENDICESAppendix 1 - Commission Member Biographies 149Appendix 2 - Groups/Individuals Invited To Make Submissions 152Appendix 3 - Statutory <strong>Health</strong> Service Providers 154Appendix 4 - Description <strong>of</strong> the Estimates <strong>and</strong> Allocations Process 160Appendix 5 - Diagnosis Related Groups/Casemix 175Appendix 6 - Audit <strong>of</strong> Structures 179Appendix 7 - Extracts from the Consultants’ Common Contract 180Appendix 8 - Integrated Management <strong>Report</strong>s 183Appendix 9 - Investment in Information Technology in the Midl<strong>and</strong> <strong>Health</strong> Board 184
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